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Definition
Bleeding more than 500ml following delivery
Primary: within 24 hours Secondary: after 24hours to 6 weeks postpartum
Epidemiology
2% of pregnancy
Most common cause of maternal mortality worldwide
Aetiology
Primary (4 Ts): TONE (MAJOR 90%)
myometrium has not contracted to cut off spiral arteries Retained placental fragments Lacerations, episiotomy, uterine rupture or inversion DIC, Haemophilia, vWD
TISSUE
TRAUMA
THROMBIN
Aetiology
Secondary: Endometritis Retained placental tissue
Risk Factor
Overdistention Atony (Multiple pregnancies, polyhydramnios, LGA). Labor & Delivery: Antepartum haemorrhage, placenta praevia. C-section (Emergency>Elective). Prolonged labor >12hour Pre-eclampsia
Previous PPH HELLP
Clinical Presentation
Bleeding continuous bleeding after delivery of placenta blood soaked pads and bedding Shock pallor collapse hypotension tachycardia
Bimanual Compression
Recognition
Replacement
Restitution
Summary
Bleeding more than 500 ml from genital tract after
delivery Primary and secondary 4t tone, tissue, trauma, thrombin Multidiscipline management
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